The public hearings are over, attended by hundreds of executives, direct support professionals, case managers and other interested parties. The massive state budget cuts looming a few weeks away will be devastating to some agencies and directly affect the lives of many. It is disheartening, after 20-plus years in the nonprofit sector, witnessing what could be the complete dismantling of a community support system that has taken decades to build.
Being a fiscal conservative, 33 years as a registered Republican, my perspective may differ from many within the social service field. However, no one is more concerned about the lives of our most vulnerable citizens.
Change is needed within Maine’s service delivery system. I have experienced continual, and often radical, changes over the past 24 years. Maine stands head and shoulders over many states when it comes to supporting individuals with disabilities. This current economic situation is not the time to dismantle a system that sets the standard across our nation. It is also not a time to improve Maine’s standing as one of the highest-taxed states in the country.
Can both be accomplished? Absolutely. My consulting work has provided a unique view into the inner workings of numerous agencies. We are blessed in Maine with a contingency of dedicated professionals providing a myriad of services to Mainers from all walks of life.
How do we accomplish both? Specifically, how do we maintain our high level of services without increasing taxes?
I am particularly struck by the generally dysfunctional relationship between nonprofit agencies and state funders, particularly the Department of Health and Human Services. I often reminisce about the past era of partnership. Services were tailored to fit a person’s needs and individualized budgets negotiated to provide those services. One party provided the funding and the other the services. When challenges arose, financial or programmatic, they were resolved as a team.
Legislators should consider four basic steps to save millions of dollars and salvage Maine’s service delivery system.
First, pay your bills. What should be a relatively simple billing process has morphed into the most complex and convoluted system imaginable. The amount of paperwork and daily tracking of whether someone brushed their teeth has morphed out of control.
Years ago, I scheduled a half-day a week to submit manual reimbursement claims. Today, organizations have entire departments, working full time with several staff to submit electronic claims, expecting 25 percent or more being rejected.
Second, collect your money. Some agencies are on the verge of bankruptcy because of unpaid claims. Others are sitting on significant amounts of cash, waiting for the state to collect it. In some cases, they are simply unable to return the funds. The state must have a financial operation that meets the needs of Maine taxpayers.
Third, get rid of excess. Some agencies have grown into inefficient, expensive bureaucracies. Others are lean with minimal overhead, providing high-quality, cost-effective services. They don’t have assistant directors, various administrative assistants, etc. DHHS must re-evaluate the amount of documentation and reporting, much of which is ignored, and expect providers to streamline their operational processes.
Finally, forget the status quo and “sacred cows.” Some providers will fight for their particular array of services and pull out all the tricks. They will put their poster person in the news, claiming quality of life will deteriorate if funding is cut. We can no longer afford duplicate services or continue those that don’t produce results. Some services, costing millions of dollars, are simply not providing an adequate return on investment. Some agencies need to fold their tents. DHHS should not continue down the path of implementing across- the-board rate cuts, but invest the time to do the hard work that is really needed.
Maine needs leadership. This is the time to re-evaluate and regroup. Together, funders and service providers must make hard decisions, balancing high ideals with fiscal reality.
Ken Bustard of Bucksport is the principal of The Accounting Coach, a corporate coaching service.